The Labyrinth of Science

“Will it be possible to cure spinal cord injuries in the future? And why is it so difficult?” These are the two most common questions we are confronted with. The answer to the first one is an emphatic yes. There will be a cure. When answering the second question, we like to compare the research process with a labyrinth. It’s difficult to find the correct path, but it is possible. There are pointers and short cuts, but also many dead ends, hurdles and forks in the road. The following four obstacles are the ones with which science struggles the most.

OBSTACLE Nº1 - WE KNOW A LOT, BUT NOT ENOUGHThe belief that spinal cord injuries are incurable prevailed for thousands of years. Evidence of this can be found on age-old Egyptian papyrus scrolls. Fortunately, this mindset changed quite dramatically over the course of the 20th century. After World War II, acute care and treatment improved significantly; this greatly increased the life expectancy of spinal cord injury patients. Before these improvements, some patients passed away within a few days – depending on the level of the injury. In terms of finding a cure, however, people still believed that the nerves in the brain and spinal cord were incapable of recovering – at least until the early 1980s. It was around this time that scientists such as Professor Samuel David began to make breakthroughs. Their experiments proved that nerve cells in the spinal cord can grow under the right conditions, even over surprisingly long distances. Throughout the following decades, research efforts were intensified. Scientists accumulated a wealth of knowledge that was highly impressive given the short timeframe. Nevertheless, researchers still need to find out much more about the countless biological mechanisms of a spinal cord injury before they can develop the cure. This leads us to obstacle number two.

OBSTACLE Nº2 - SPINAL CORD INJURIES ARE COMPLEXIn the field of spinal cord research, scientists are battling against an injury that encroaches on a highly complex system, triggering a chain reaction of malign events within the body. The initial phase after a trauma is characterised by haemorrhaging and inflammation in the spinal cord. During this phase, cells die rapidly. In the second phase, the cellular demise increases even more and spreads to the tissue surrounding the site of the injury. In other words, the body itself exacerbates the injury. During the final, chronic phase, the damaged area is enclosed and “sealed” by a scar. What remains is a detrimental cyst.

OBSTACLE Nº3 - RESEARCH IS EXPENSIVEMedical research requires an enormous amount of funding. This rings especially true in the context of complex diseases such as cancer, strokes, or spinal cord injuries. In terms of funding, spinal cord research struggles a good deal more than its “peers”. The reason for this is that spinal cord injuries are not considered a widespread disease that affects millions of people. According to the World Health Organisation, “only” around 250,000 to 500,000 people per year suffer from this kind of devastating injury. Consequently, the proportion of public funds allocated for its research is very low. Even the pharmaceutical industry, which is normally a “big player” in terms of research funding, is rarely interested in investing. This is largely due to the fact that pharmaceutical companies are inherently profit-oriented. Investments in the millions are simply too risky when there is no prospect of returns. The regrettable consequence is that spinal cord research is largely underfunded. The field still suffers from a lack of resources, especially in terms of translating basic scientific knowledge into therapeutic applications. (see issue four) What’s more, the less money that is available in a certain field of research, the more difficult it is to motivate new talent to contribute. This is, by definition, a vicious circle.

OBSTACLE Nº4 - THE VALLEY OF DEATH LOOMSThe biggest hurdle on the path to finding a cure is the so-called translation. This term describes the step from basic research to clinical application. Every potential medication or therapy needs to clear this hurdle before it can be used on actual patients. Unfortunately, this step is not only fraught with risks, but also immensely timeconsuming and expensive. First of all, the work of a researcher needs to be reproduced in its entirety by a different scientist. Then the scientists are required to develop a highly complicated protocol for clinical trials. This protocol needs to address numerous questions such as: “How and where should the drug be administered to achieve optimal results?” Other necessary steps include obtaining regulatory approvals, pharmacological assessments, patents, and much more. In respect thereof, research lacks both resources and defined patterns of responsibility. In practice, the hurdles are so numerous and daunting that scientists have even coined their own term for the phenomenon: Valley of Death.

NAVIGATING THE LABYRINTHThe good news is that science is undertaking immense efforts to overcome these obstacles and has already made huge strides forward. Wings for Life can proudly claim to have made a decisive contribution to this progress. As far as “Obstacle No. 1 and 2” are concerned, researchers have managed to decipher most of the complex processes triggered by a spinal cord injury in recent years. Their focus is now on finding therapeutic applications, and they are already testing these in some cases. NGOs and their respective donors have started tackling the financing issue. The financial requirements are still immense, but the funding gap has decreased. In the past decade, Wings for Life alone has invested many millions in this particular field of research. In order to manage the scarce resources as effectively as possible, we have developed a series of measures. For example, a strict selection process ensures that we only fund the most promising research projects. In addition, we support initiatives aimed at improving collaboration and unified scientific standards.

We finance projects that strive to improve the analysis of large amounts of data and organize our own scientific conferences. Last but not least, we encourage scientists to share their findings – even if they are negative. This ensures that researchers don’t waste money and energy on projects that would lead them into the same dead end as others. The last remaining problem is “Obstacle No. 4”,the so-called Valley of Death. In order to “translate” more medical discoveries into actual therapeutic treatments for patients, we launched the Accelerated Translational Programme (ATP) in 2016. This not only supports researchers with money, but also with a network of experts and the necessary know-how. “So when will there be a cure?” We cannot answer that question with any certainty just yet. But as you can see, we are working on it.

KEY AREAS OF MODERN SPINAL CORD RESEARCHNeuroprotection: The aim of this research strategy is to prevent the massive breakdown of cells and thus for the patient to retain as many bodily functions as possible.

Plasticity: In this field, researchers are attempting to reorganise nerve circuits and to encourage undamaged nerves to take over functions of other nerves. Regeneration: Without external stimulation,mature nerve cells do not re-grow after an injury. Therefore, scientists are looking for ways to stimulate and accelerate this process.

Remyelination: This area of research focuses on restoring the myelin layer of “naked” nerve fibres. Similar to a power cable, this special protective cover is required to restore the conductivity of nerve fibres.

Reconstruction: This research field strives to replace damaged tissue with stem cells or biomaterials.

Rehabilitation: Rehabilitation projects are not aimed at the biological healing of the injured spinal cord, but strive to compensate for lost bodily functions. This also includes attempts to restore bladder function or to alleviate neuropathic pain.

Imaging: This area concerns imaging procedures that make spinal cord injuries and the results of therapeutic measures visible in detail.